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HomeMy WebLinkAboutWM0100555_Monitoring Well Construction Application_20230901FOR OFFICE USE ONLY PERMIT NO. ISSUED DATE NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY - DIVISION OF WATER RESOURCES APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM PLEASE TYPE OR PRINT CLEARLY In accordance with the provisions of Article 7, Chapter 87, General Statutes of North Carolina and regulations pursuant thereto, application is hereby made for a permit to construct monitoring or recovery wells. 1. Date:09/01/2023 2. County: Caldwell 3.What type of well are you applying for? (monitoring or recovery):Monitoring 4. Applicant:NCDEQ Telephone: 919-707-8168 Applicant’s Mailing Address: 1646 Mail Service Center, Raleigh, NC 27699 Applicant’s Email Address (if available): scott.ryals@ncdenr.gov 5. Contact Person (if different than Applicant): Greg Hans Telephone: 704-325-5408 / 617-828-9948 Contact Person’s Mailing Address: 3525 Whitehall Park Drive, Suite 150, Charlotte, NC 28273 Contact Person’s Email Address (if available): ghans@ces-group.net 6. Property Owner (if different than Applicant): Caldwell County Telephone: N/A Property Owner’s Mailing Address: P.O. Box 2200 Property Owner’s Email Address (if available): N/A 7. Property Physical Address (Including PIN Number:) 214 Mulberry Street NW PIN: 2749872930_____ City Lenoir County Caldwell Zip Code: 28645 8. Reason for Well(s): Assessment (ex: non-discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.) 9. Type of facility or site for which the well(s) is(are) needed:USTs (ex: non-discharge facility, waste disposal site, landfill, UST, etc.) 10. Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s). No known water quality permits. UST Incident No. 17199 11. Type of contaminants being monitored or recovered:organics / metals (ex: organics, nutrients, heavy metals, etc.) 12. Are there any existing wells associated with the proposed well(s)? If yes, how many?No Existing Monitoring or Recovery Well Construction Permit No(s).:N/A 13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): To be installed within Source Area 14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No known If yes, give distance(s): 15. Well Contractor: Carolina Soil Investigation Certification No.: Corey Speece #2904 / Daniel Summers #2579 Well Contractor Address: 132 Gurney Road, Olin, NC 28660 PROPOSED WELL CONSTRUCTION INFORMATION 1. As required by 15A NCAC 02C .0105(f)(7), attach a well construction diagram of each well showing the following: a. Borehole and well diameter e. Type of casing material and thickness b. Estimated well depth f. Grout horizons c. Screen intervals g. Well head completion details d. Sand/gravel pack intervals Continued on Reverse WM0100555 9/5/2023 PROPOSED WELL CONSTRUCTION INFORMATION (Continued) 2. Number of wells to be constructed in unconsolidated material: 1 3. Number of wells to be constructed in bedrock: 0 4. Total Number of wells to be constructed: 1 (add answers from 2 and 3) 5. How will the well(s) be secured? 2 x 2 pad, well covers, locking j-plug 6. Estimated beginning construction date: Week of 9/18/2023 7. Estimated construction completion date: Same Day ADDITIONAL INFORMATION 1. As required by 15A NCAC 02C .0105(f)(5), attach a scaled map of the site showing the locations of the following: a. All property boundaries, at least one of which is referenced to a minimum of two landmarks such as identified roads, intersections, streams, or lakes within 500 feet of the proposed well or well system. b. All existing wells, identified by type of use, within 500 feet of the proposed well or well system. c. The proposed well or well system. d. Any test borings within 500 feet of proposed well or well system. e. All sources of known or potential groundwater contamination (such as septic tank systems, pesticide, chemical or fuel storage areas, animal feedlots as defined in G.S. 143-215.10B(5), landfills, or other waste disposal areas) within 500 feet of the proposed well or well system. SIGNATURES The Applicant assumes total responsibility for ensuring that the well(s) will be located, constructed, maintained, and abandoned in accordance with 15A NCAC 02C. Environmental Division Manager Signature of Applicant or *Agent Title of Applicant or *Agent Greg Hans * If signing as Agent, attach authorization agreement stating Printed name of Applicant or *Agent that you have the authority to act as the Agent. If the property is owned by someone other than the Applicant, the property owner hereby consents to allow the Applicant to construct well(s) as outlined in this Well Construction Permit application and acknowledges that it shall be the responsibility of the Applicant to ensure that the well(s) will be located, constructed, maintained, and abandoned in accordance with 15A NCAC 02C. (See attached Access Agreement with NCDEQ State Trust Fund) Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant) DIRECTIONS Please send the completed application to the appropriate Division of Water Resources’ Regional Office: Asheville Regional Office 2090 U.S. Highway 70 Swannanoa, NC 28778 Phone: (828) 296-4500 Fax: (828) 299-7043 Fayetteville Regional Office 225 Green Street, Suite 714 Fayetteville, NC 28301-5094 Phone: (910) 433-3300 Fax: (910) 486-0707 Mooresville Regional Office 610 East Center Avenue Mooresville, NC 28115 Phone: (704) 663-1699 Fax: (704) 663-6040 Raleigh Regional Office 3800 Barrett Drive Raleigh, NC 27609 Phone: (919) 791-4200 Fax: (919) 571-4718 Washington Regional Office 943 Washington Square Mall Washington, NC 27889 Phone: (252) 946-6481 Fax: (252) 975-3716 Wilmington Regional Office 127 Cardinal Drive Extension Wilmington, NC 28405 Phone: (910) 796-7215 Fax: (910) 350-2004 Winston-Salem Regional Office 450 W. Hanes Mill Road Suite 300 Winston-Salem, NC 27105 Phone: (336) 776-9800 Fax: (336) 776-9797 GW-22M/R (Rev. 5-26-2022) Imagery ©2023 Burke County, CNES / Airbus, Maxar Technologies, U.S. Geological Survey, Map data ©2023 Google 20 ft Caldwell County Sheriff's Oce Proposed Monitoring Well Location Proposed Monitoring Well MW-1 TYPICAL  FLUSH­MOUNT GROUNDWATER MONITORING WELL  CONSTRUCTION DIAGRAM  BOLTED MANHOLE COVER  CONCRETE PAD  MANHOLE SLEEVE  LOCKING WELL CAP  2” SCHEDULE 40 PVC PIPE  BENTONITE GROUT  BENTONITE SEAL  TYPE _________  SAND PACK  GRAIN SIZE _________  2” SLOTTED SCHEDULE  40 PVC SCREEN  BOTTOM CAP  BOTTOM OF BORING  ANNULUS  (SPACING DEPENDS  ON WELL DEPTH)  2 FEET  2 FEET  10 FEET  6”  6”  1”­2”  2”­3”  2”­3”  (TOP OF MANHOLE)  (TOP OF CASING)  ENVIRONMENTAL PROTECTION  HAZARDOUS SITES RESPONSE PROGRAM